Ligation clip and clip applier

ABSTRACT

The ligation clip applicator and ligation clip design are provided which are particularly applicable to placement of a surgical ligation clip during a laparoscopic surgical procedure. The clip includes a support member and a clamping arm having enlarged portions thereon. The applicator device has a magazine including first and second longitudinally extending partially closed channels within which the enlarged portions of the support member and the clamping arm are received with the clip held in an open position. First and second articulated jaws are attached to the magazine and have first and second channel extensions therein aligned with the first and second channels of the magazine, so that a clip can be received from the magazine in the jaws with the first and second enlarged portions of the support member and the clamping arm being received in the first and second channel extensions of the jaws. The channel extensions include first and second releasing openings. The jaws are closed about a vessel to pre-clamp the vessel. The clip is pushed forward into the jaws to a position where the enlarged portions of the support member and the clamping arm are aligned with the releasing openings and the support member and the clamping arm are released allowing the support member and the clamping arm to move toward each other to ligate the vessel therebetween.

BACKGROUND OF THE INVENTION

[0001] 1. Field of The Invention

[0002] The present invention relates generally to mechanical devicesused in surgical procedures to obtain ligation or hemostasis, and moreparticularly, to low profile tools that can apply a pre-formed, springloaded ligation clip used during surgery to clamp around a vessel orduct, such as the cystic duct, and thereby obtain ligation.

[0003] 2. Description of the Prior Art

[0004] It will be appreciated by those skilled in the art that the useof ligation clips to control bleeding during surgical procedures is willknown. As described, for example, in U.S. Pat. Nos. 4,976,722 and4,979,950 prior art clips are generally formed of metal wire, usually atitanium alloy, having a “U-shaped” rectangular cross-section. Suchprior art clips often include a grooved pattern machined into the inneror clamping surfaces of the clip, in an attempt to enhance the abilityof the clip to remain in position after it is closed around the vessel.Application of the clip to the vessel is normally effected by means of acrushing action produced by a clip applier, such as the disclosed inU.S. Pat. No. 5,030,226. Such crushing actions, of course, permanentlydeform the clips, making them difficult to remove or re-position.

[0005] Prior art surgical ligation clips have several inherent problems.For example, the force applied by the clip to the vessel can be variableand inconsistent from one clip to the next, because of the variation incrushing force applied to the clip by the user. Further, prior art clipshave a tendency to slip off the end of the blood vessel stub (i.e.,perpendicular to the axis of the vessel) to which it has been applied,because of the low coefficient- of friction associated with the clip,and lack of adequate restraining force provided by the clip. Because ofthis, separation of the clip from the vessel to which it has beenapplied, after the wound has been closed, is not uncommon. A relatedproblem found in the prior art is the fact that the ligating orrestraining force offered by the crushed clip varies along the length ofthe clip, decreasing toward the open end. Thus, the section of thevessel near the open end of the clip can be inadequately ligated.

[0006] It is also common in the prior art to actually form and crush theclip only at the time of its application to the targeted blood vessel.It is often required that the vessels of 4 mm and larger diameter beligated. Because most clips of the prior art have no spring action it isrequired that the inside clearance dimension of the clip, prior tocrushing, be larger than the vessel. This does not lend itself to clipapplier designs that will pass through small 5 mm trocars. The appliermust be inserted through a trocar placed through the patient's externaltissues and into the surgical field. Thus, prior art ligation clipappliers used in laparoscopic procedures universally consist of a 10 mmdiameter clip applier that can fit only through a trocar having a 10 to11 mm diameter entry port. Because one goal of laparoscopic surgery isto minimize the size of the entry wound, a surgical ligation clip andclip applier that can be used within a 5 mm or even a 2.5 mm diametertrocar port is highly desirable.

[0007] New minimally invasive surgical procedures and the need for lessinvasiveness for current procedures require the development of smallerand smaller devices. The harvesting of saphalous veins and certaincardiovascular procedures would benefit from reduced diameters trocars,below 3 mm diameter.

[0008] To address these problems a new spring action surgical clip wasdesigned, as illustrated in FIGS. 1 and 2 in U.S. Pat. No. 5,593,414,which is assigned to the assignee of the present invention and isincorporated herein by reference. This clip has a vessel clamping arm, avessel support member, and at least one tension coil integrally joiningthe arm and support member. The clip is pre-formed so that in itsequilibrium state, it can be easily placed within the surgical field,including through an endoscopic trocar port with as little as 5 mmdiameter. After the clip is placed proximate the blood vessel or duct tobe clamped, the clamping arm is moved from its equilibrium position to aposition under higher tension, allowing positioning of the vesselbetween the arm and support member. When correct placement andpositioning is achieved, the arm is released and, as the arm tends tomove back towards its equilibrium position, it clamps the vessel betweenthe arm's curved lower surface and the supporting upper surface of thevessel support member.

[0009] To enhance the performance of the tension coil(s), the vesselsupport member includes first and second arms, one of which terminatesin a 180° bend section. Minimal cross-sectional area of the clip isachieved by substantially longitudinally aligning the vessel supportmember, the clamping arm, the 180° bend section, and the tension coil.

[0010] The clamping arm is pre-formed into an equilibrium that generallyaligns with the horizontal plane of the support member. A secondembodiment of the clip pre-loads the clamping arm into a pre-loadedequilibrium position where the free end of the arm rests against theupper surface of the support member.

[0011] There exists a relationship between the diameter of the trocar(hence the applier tube) and the maximum diameter of a vessel that canbe ligated. Older crush clip technology limits the ratio of wound sizeto maximum diameter to be ligated to greater than 2. That is, to ligatea 5 mm vessel a puncture would of 10-12 mm is required. U.S. Pat. No.5,593,414 teaches the method of using a spring clip that is insertedinto the surgical field in the closed state, opened over a vessel, thediameter of which has been reduced, or preclamped , by the tool, andclosed over the preclamped vessel. This method allows an entry wound tovessel diameter of 1 or smaller. Thus, a 5 mm vessel can be ligatedthrough a 5 mm trocar, substantially less invasive as compared to theolder crush clip technology. For a trocar diameter of 2.5 mm the clipcan be scaled down to approximately half size on the wire diameter, coilheight, and length and still supply an acceptable ligation force on a2.5 mm vessel.

[0012] Unfortunately, several problems are encountered in applying thespring action ligation clip of U.S. Pat. No. 5,593,414 to a vesselthrough a 5 mm or small trocar port. First, the nominal 5 mmcross-section of the clip that is inserted through the trocar placessevere design restrictions on any applier mechanism. Second, care mustbe taken so that the elastic limit of the spring material is notexceeded when the clip is opened up so that it can be placed over thevessel diameter. For the titanium wire of diameter 0.75 mm, for example,lifting the distal end of the center leg of the spring much above a fewmm will exceed the elastic limit. Secondly, these spring clips are smalland compact and owing to the preload, have a great deal of energy storedin the spring. As these clips are opened to place them over a vessel thestored energy increases substantially, in some cases more than doubling.This energy makes controlling the clip, to insure proper installation,difficult. Undesirable translation or rotation can result inmisplacement or dropping of the clip inside the body.

[0013] What is needed, then, is a spring clip that includes a means thatallows positive control of the clip during the installation process anda clip applier tool that can be used to place a pre-formed spring actionligation clip around a large diameter vessel without permanentlydeforming or weakening the clip, one that will compress, withoutcrushing the vessel, and yet be small enough to use in through a 5 mm orsmaller trocar. Also needed is a design which will avoid the mechanicaldifficulty of opening the clips prior to placement of the clips on thevessel.

[0014] Another approach which has been proposed to provide smallerdiameter endoscopic clip application is that of U.S. Pat. No. 5,601,573to Fogelberg et al. Fogelberg et al. still struggles with the complexmanipulation required to advance the clip in a closed position and thenopen the clip prior to placement. Fogelberg et al. also has anoverly-complex multi-stage trigger arrangement for actuation of the jawsand the clip advancement mechanism. The present invention presentsseveral improvements over Fogelberg et al. including: (1) advancement ofthe clips in their open position rather than a closed position; and (2)a smooth single stage trigger action which simultaneously closes thejaws and advances the fowardmost clip into the jaws. Another differencebetween the present invention and Fogelberg et al., is that Fogelbergpushes a stack of clips, whereas the present invention individuallyengages and pushes each clip simultaneously, thus yielding bettercontrol of the clips.

SUMMARY OF THE INVENTION

[0015] A surgical ligation clip constructed in accordance with thepresent invention includes support member and the clamping arm with aconnector, such as a coil spring, joining the support member and theclamping arm. The clip includes first and second enlarged ends definedon the support member and the clamping arm respectively. The enlargedends are first and second wire loops integrally formed with the supportmember and the clamping arm of the clip. These enlarged ends providefirst and second control surfaces.

[0016] Clips such as the one just described are received in an openposition in a magazine of a clip applier. The magazine has first andsecond longitudinally extending, partially closed channels. The enlargedends of the spring clip are received in and trapped within the first andsecond channels of the magazine which hold the clip in its openposition.

[0017] First and second articulated jaws are attached to the magazine.The jaws have channel extensions therein aligned with the first andsecond channels of the magazine, so that the clip can be received fromthe magazine in the jaws with the first and second control surfaces orenlarged ends of the support member and the clamping arm being receivedin the first and second channel extensions of the jaws.

[0018] The first and second channel extensions of the jaws include firstand second releasing openings, respectively, which are larger than thefirst and second enlarged ends of the support member and the clampingarm, so that when the clip is pushed forward in the jaws to a positionwhere the control surfaces are aligned with the releasing openings, thesupport member and the clamping arm are released thereby allowing thespring to move the support member and the clamping arm toward each otherto ligate a blood vessel or other body duct therebetween.

[0019] An actuator is operably associated with the jaws and movablebetween a first position in which the jaws are open, and a secondposition in which the jaws are closed.

[0020] It is therefore an object of the present invention to provide animproved surgical ligation clip and applicator assembly.

[0021] Another object of the present invention is the provision ofimproved surgical ligation clips.

[0022] Still another object of the present invention is the provision ofimproved surgical ligation clip applicator tools.

[0023] And another object of the present invention is the provision ofimproved methods of ligating blood vessels and ducts.

[0024] Still another object of the present invention is the provision ofimproved ligation clips and applicator tools which are capable of beinginserted through relatively small openings in the body, 5 mm diameter orsmaller.

[0025] Another object of the present invention is the provision ofapparatus and methods whereby the spring clip is held in its openposition as it is advanced through the magazine of the apparatus.

[0026] Yet another object of the present invention is the provision ofan improved clamping jaw design having first and second spaced clampingpoints along the length of the lumen.

[0027] Still another object of the present invention is the provision ofimproved methods of ligating a lumen including preclamping the lumen atfirst and second spaced clamping points, then placing a spring clip overthe lumen and clamping the lumen with a spring clip at a third pointlocated between the first and second points.

[0028] Still another object of the present invention is the provision ofapparatus and methods for ligating a stub end of a lumen.

[0029] Other and further objects, features and advantages of the presentinvention will be readily apparent to those skilled in the art upon areading of the following disclosure when taken in conjunction with theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

[0030]FIG. 1 is an exploded view of the clip applicator of the presentinvention.

[0031]FIG. 2 is an enlarged sectioned view of the upper portion of theapplicator barrel, with the trigger in the 0% engaged position.

[0032]FIG. 3 is an enlarged sectioned view of the operating end of theapplicator corresponding to the 0% engaged position of the trigger inFIG. 2, and showing the jaws in their open position.

[0033]FIG. 3A is a cross-sectional view taken along line 3A-3A of FIG.3.

[0034]FIG. 4 is a is an enlarged section view of the upper portion ofthe applicator with the trigger in the 100% engaged position.

[0035]FIG. 5 is an enlarged sectioned view of the operating end of theapplicator corresponding to the 100% engaged position of the trigger inFIG. 3, and showing the jaws in their closed position.

[0036]FIG. 6 is an elevation view of the apparatus of FIG. 1, with thejaws in the open position.

[0037]FIG. 7 is an elevation view of the apparatus of FIG. 1, with thejaws in the closed position.

[0038]FIG. 8 is a side elevation view of the ligation clip used with theapparatus of FIG. 1, showing the ligation clip with the support memberand the clamping arm in an open position.

[0039]FIG. 9 is a perspective view of the clip of FIG. 8 with thesupport member and the clamping arm in a fully closed or pre-loadedequilibrium position.

[0040]FIG. 10 is a top plan view of the clip of FIG. 8.

[0041]FIG. 11 is a side elevation view of the clip of FIG.10 in a closedposition.

[0042]FIG. 12 is a right end elevation view of the clip of FIG. 10 in aclosed position.

[0043]FIG. 13 is a perspective view of the clip magazine of theapparatus of FIG. 1.

[0044] FIG.14 is an enlarged top plan view of the right end portion ofthe magazine of FIG. 13.

[0045]FIG. 15 is an elevation sectioned view taken along line 15-15 ofFIG.14.

[0046]FIG. 16 is a right end view of the magazine of FIG. 14.

[0047]FIG. 17 is an enlarged side elevation view of the left end portionof the magazine of FIG. 13.

[0048]FIG. 18 is an enlarged side elevation view of the right endportion of the magazine of FIG. 13.

[0049]FIG. 19 is a perspective view of a pair of jaws of the apparatusof FIG. 1.

[0050]FIG. 20 is a top plan view of the top jaw of FIG. 19.

[0051]FIG. 21 is a front elevation view of the jaw of FIG. 20.

[0052]FIG. 22 is a bottom view of the jaw of FIG. 20.

[0053]FIG. 23 is a sectioned elevation view of the jaw taken along line23-23 of FIG. 21.

[0054]FIG. 24 is an elevation longitudinally sectioned view of the topjaw taken along line 24-24 of FIG. 20.

[0055]FIG. 25 is a plan view of the elongated pusher rod.

[0056]FIG. 26 is an elevation sectioned view of the pusher rod takenalong line 26-26 of FIG. 25 and showing the upturned prongs.

[0057]FIG. 27 is an enlarged view of one of the upturned prong portions.

[0058]FIG. 28 is an enlarged view of the left end portion of the pusherrod of FIG. 25.

[0059]FIG. 29 is a perspective view of the pusher rod piston.

[0060]FIG. 30 is a perspective view of the primary outer tube piston.

[0061]FIG. 31 is a perspective view of the actuator.

[0062]FIG. 32 is a perspective view of the intermediate outer tubepiston.

[0063]FIG. 33 is a top plan view of the outer tube.

[0064]FIG. 34 is a front elevation view of the right end portion of theouter tube of FIG. 33.

[0065]FIG. 35 is a left end view of the outer tube of FIG. 33.

[0066]FIG. 36 is a top plan view of the clip of FIGS. 8-12 in placeabout a lumen which has been ligated between the support member and theclamping arm.

[0067]FIG. 37 is a perspective view of the clip and lumen of FIG. 36.

[0068]FIG. 38 is a perspective view showing the clip of FIGS. 8-12 beingused to ligate a stub end of a lumen.

[0069]FIG. 39 is a forward end view of the intermediate outer tubepiston of FIG. 32.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0070] Referring now to the drawings, and particularly to FIGS. 1-7, asurgical clip applicator apparatus is there shown and generallydesignated by the numeral 10. The apparatus 10 includes a body or handleportion 12, a barrel portion 14, a trigger 16, an outer tube 18, andfirst and second articulated jaws 20 and 22.

[0071] As seen in the exploded view of FIG. 1, the handle portion 12 isformed from two molded plastic handle portion halves 12A and 12B. Acylindrical forwardly extending handle projection 13 is integrallyformed with the handle 12. A barrel 14 which is also referred to as arotator 14, is received over the cylindrical extension 13. A rotatorring 15 is attached to the rear end of the barrel 14. The barrel orrotator 14 and the attached tube 18, can be rotated about itslongitudinal axis relative to handle 12.

[0072] It is noted that in this disclosure the terms forward andrearward are utilized from the viewpoint of a person holding theapparatus 10, so that the forward end 26 of the barrel 14 faces awayfrom the person who is holding the handle 12 and trigger 16 in theirhand while pointing the apparatus 10 away from themselves.

[0073] The inner details of construction of the apparatus 10 are bestseen in the enlarged sectioned views of FIGS. 2-5.

[0074] The barrel 14 has a bore 24 defined through its forward end 26.The outer tube 18 is received in the barrel bore 24, and is slidabletherein as is further described below.

[0075] The details of construction of the outer tube 18 are best shownin FIGS. 33-35. Outer tube 18 has a rearward end 28 and a forward end30. The rearward end 28 includes an annular flange 32.

[0076] As seen in FIG. 35, the flange 32 has a couple of orientationrecesses 34 and 36 defined therein.

[0077] The flanged rear end 28 of outer tube 18 is attached to anintermediate outer tube piston 38. The piston 38 may also be referred toas a jaw pusher 38. The details of construction of piston 38 are bestseen in FIGS. 32 and 39. FIG. 39 is a forward end view of piston 38, andas shown there, the forward end 40 of piston 38 has a bore 42 and acounterbore 44 defined therein. As seen in FIG. 32, the piston 38 has asmaller diameter rearward portion 46 and a larger diameter forwardportion 48. The larger diameter forward portion 48 has a pair ofdiametrically opposed slots 50 and 52 defined therein, the purposeof-which is further described below.

[0078] The attachment of the outer tube 18 to the intermediate outertube piston 38 is accomplished by closely receiving the flange 32 of therearward end of tube 18 within the counter bore 44 of piston 38 so thatthe orientation recesses 34 and 36 fit over orientation bumps 54 and 56(see FIG. 39) defined on the piston 38. Thus, as the intermediate outertube piston 38 is pushed forward it pushes against the flange 32 of tube18 thus moving the tube 18 forward and compressing return spring 152. Asthe tube 18 moves forward it pivots the jaws closed. On release of thetrigger 16, the return spring 152 pushes the tube 18 rearward so that itfollows the rearward movement of piston 38.

[0079] Concentrically contained within the outer tube 18 is a clipmagazine 58. The details of construction of the magazine 58 are shown inFIGS. 13-18. As best shown in the end view of FIG. 16, the magazine 58is a one piece tubular member which has first and second longitudinallyextending partially closed channels 60 and 62 defined therein.

[0080] The channels 60 and 62 are partially closed by radially inwardextending longitudinal ledges 61 and 63. Thus each channel such aschannel 60 has an inner dimension which is greater than the width of theopening between ledges 61 and 63 thus allowing an enlarged end such asthe loops 72 and 74 of clip 64 to be trapped within the channels 60 and62.

[0081] The details of construction of the clips 64 are best seen inFIGS. 8-12.

[0082] The clip 64 is shown in FIG. 8 in an open position and in FIG. 9in a closed or pre-loaded equilibrium position. FIGS. 10, 11 and 12 aretop, front and end views of the clip of FIG. 9 in the closed position.

[0083] The clip 64 includes a support member 66 and a clamping arm 68. Acoil tension spring 70, which may also be generally referred to as aconnector 70, joins the support member 66 and clamping arm 68.

[0084] Support member 66 has a first enlarged end 72 defined thereon.Clamping arm 68 has a second enlarged end 74 defined thereon. The firstand second enlarged ends 72 and 74 are first and second wire loops whichare integrally formed with the support member 66 and clamping arm 68 ofclip 64.

[0085] The loops 72 and 74, and particularly the laterally outerportions thereof, may be described as first and second control surfaces72 and 74 defined on the support member 66 and clamping arm 68,respectively, the first and second control surfaces 72 and 74 beingreceived in and trapped within the first and second channels 60 and 62,respectively. As best seen in FIG. 5, a plurality of ligating clips 64are received in the magazine 58, in their open position. For ease ofidentification, consecutive clips beginning with the fowardmost one aredesignated as 64A, 64B, 64C, etc. The control surfaces 72 and 74, asengaged by channels 60 and 62, prevent rotation and yawing of the clip64 as the clip is moved through the magazine 58.

[0086] The connector 70 is preferably a coil spring biasing means whichhas a preload which biases the support member 66 and clamping arm 68toward each other. The preload is preferably such that when the clip 64is in the fully closed or pre-loaded equilibrium position shown in FIG.9, there is still a spring preload in connector 70 which forces the wireloops 72 and 74 against each other.

[0087] The spring 70 preferably provides a preload force between thesupport member 66 and clamping arm 68 of at least 100 grams force whenthe support member 66 and clamping arm 68 are in a closed or pre-loadedequilibrium position as shown in FIG. 9.

[0088] The clip 64 is preferably formed from a single length of wire.The clip 64 includes a transverse spindle 76 having a first free end 78and terminating in a bend 80 which leads to a first longitudinal member82 which terminates in first wire loop 72 which leads to a secondlongitudinal member 84 lying parallel to first longitudinal member 82and spaced therefrom. The first wire loop 72 has a transverse dimensionor width 86 (see FIG. 12) greater than a transverse distance 88 (seeFIG. 10) across the first and second longitudinal members 82 and 84. Thesecond longitudinal member 84 terminates in the coil spring connector 70which is wrapped around the transverse spindle 76. The coil springconnector 70 leads to a third longitudinal member 90 which terminates inthe second wire loop 74 which terminates in a second free end 89.

[0089] The support member 66 can be described as including two parallelspaced apart lengths of wire 82 and 84 lying in a first plane, and theclamping arm 68 can be described as including a single length of wire 90which pivots about the spring 70 in a second plane normal to the firstplane and intersects the first plane between the two parallel spacedapart lengths of wire 82 and 84 of the support member 66. The clip 64preferably has a throat length 212 (see FIG. 10) of no greater thanabout 10 mm.

[0090] It is noted that the construction of clip 64 actually provides adouble ligation of the vessel 100 as seen in FIG. 36. One ligation isformed between longitudinal members 82 and 90, and a second ligation isformed between longitudinal members 84 and 90.

[0091] The manner in which the clips 64 are received in magazine 58 isbest seen in FIGS. 3 and 5. There it is apparent that the first andsecond wire loops 72 and 74 are received in the first and secondchannels 60 and 62, respectively, of magazine 58 with the clip 64 in anopen position. The opening distance 213 is best seen in FIG. 8. Distance213 is approximately 0.75 mm.

[0092] It is noted that the clip 64 only needs to be open the relativelysmall distance 213 because the vessel or lumen 100 (see FIGS. 36-38)being clamped will already be pre-clamped by jaws 20 and 22.

[0093] Also, it can be seen in FIG. 3 that the coil spring 70, the coilsof which stand generally vertically in the plane of FIG. 3 are partiallyreceived in a recess 91 of the magazine 58. The recess 91 is best shownin FIG. 16.

[0094] The manner in which the wire loops 72 and 74 are received inchannels 60 and 62 prevents rotation of the clips 64 as they movelongitudinally through the length of magazine 58. The biasing force ofspring 70 causes the loops 72 and 74 to grip the ledges 61 and 63 whichprovides a frictional resistance to movement of the clips through themagazine 58.

[0095] The manner in which the clips 64 are moved along the length ofthe magazine 58 is further described below, but first the complementaryrelationship between the magazine 58 and the first and second jaws 20and 22 will be described.

[0096] The jaws 20 and 22 are best shown in FIGS. 19-24. It is notedthat the jaws 20 and 22 are identical, and so the details ofconstruction of only one of them will be described.

[0097] The jaws 20 and 22 have first and second channel extensions 92and 94 defined therein which are aligned with the first and secondchannels 60 and 62 of magazine 58 when the jaws are in their closedposition. The shape of second channel extension 94 is best shown in thecross-sectional view of FIG. 23. The channel extensions permit the clips64 to be pushed forward out of the channels 60 and 62 of magazine 58into the jaws 20 and 22 with the first and second wire loops 72 and 74being received in the first and second channel extensions 92 and 94 ofthe jaws.

[0098] The first and second channel extensions 92 and 94 further includefirst and second releasing openings 96 and 98. It is noted that thereleasing openings 96 and 98 are generally circular in shape and are ofa larger diameter than are the wire loops 72 and 74. Thus, when the clip64 is pushed forward into the jaws 20 and 22 until the wire loops 72 and74 are aligned with the releasing openings 96 and 98, the support member66 and clamping arm 68 will be released thus allowing the support member66 and clamping arm 68 to move toward each other due to the force fromcoil spring 70, thus closing the clip 64. As the support member 66 andclamping arm 68 move toward each other they may ligate a lumen 100therebetween as seen in FIGS. 36 and 37.

[0099] First jaw 20 has a pair of pivot pin stubs 95 extending laterallytherefrom. Similarly, second jaw 22 has a pair of pivot pin stubs 97extending laterally therefrom. As best seen in FIGS. 3, 15 and 18, thepivot pin stubs are received in lateral holes 99 defined through forwardextending tabs 101 and 103 defined on the forward end of clip magazine58. Thus, the jaws 20 and 22 are mounted upon magazine 58 so as to pivotabout their pivot pins 95 and 97.

[0100] Each of the jaws 20 and 22 also includes a tab 105 or 107,respectively which is constructed for engagement with the outer tube 18.As best seen in FIG. 3 and 33, the tab 105 of lower jaw 20 is receivedin a lateral opening 109 in the lower face of tube 18, and the tab 107of upper jaw 22 is received in a lateral opening 111 defined in theupper face of tube 18. Thus, as outer tube 18 is reciprocated back andforth relative to magazine 58, it pushes and pulls on the tabs 105 and107 thus causing the jaws 20 and 22 to pivot about their pin stubs 95and 97 between an open position as shown in FIG. 3 and a closed positionas shown in FIG. 5.

[0101] The jaws 20 and 22 have windows 113 and 115 defined therein ondiametrically opposite sides of the longitudinal axis of outer tube 18.This allows the vessel which is being clamped by the jaws to be viewedthrough the windows.

[0102] It is noted that one particular advantage provided by the presentinvention is due to the blunt shaped forward ends 208 and 210 of thejaws which are each semispherical in nature so that when the jaws arefully closed, they define a bullet shaped forward probe end 208, 210, asbest seen in FIG. 5. This permits the surgeon to close the jaws 20 and22 and use the apparatus 10 as a probe.

[0103] The mechanism which controls the operation of the jaws 20 and 22and advances the clips 64 through the magazine 58 into the jaws 20 and22 will now be described.

[0104] As best seen in FIG. 3, there is a pusher rod or pusher bar 102which has a plurality of prongs 104 extending therefrom. Pusher rod 102may also be referred to as a driver rod 102.

[0105] The details of construction of pusher rod 102 are best seen inFIGS. 25-28. The pusher rod 25 includes a plurality of prongs 104 whichextend therefrom into engagement with the clips 64 contained in themagazine as seen in FIG. 3. The pusher rod 102 is an elongated flat bar.The pusher rod 102 is slidably received in an open channel 106 (see FIG.16) defined on the outer surface of magazine 58. Also received in theopen channel 106 on the opposite side of pusher rod 102 is a flat stripof resilient foam material 93 which serves as a spring to resilientlyhold the prongs 104 in engagement with clips 64.

[0106] The pusher rod 102 includes first and second slots 108 and 110defined therethrough near its rearward end 112. The slots 108 and 110provide a means for connection of the pusher rod 102 to a pusher rodpiston 114.

[0107] The details of construction of pusher rod piston 114 are bestseen in FIG. 29. The piston 114 has a rearward end 116 and a forward end118. A portion of the pusher rod 114 adjacent forward end 118 has a flat120 defined thereon which has first and second keys 122 and 124extending upward therefrom. The keys 122 and 124 are constructed to bereceived in the slots 108 and 110 respectively of pusher rod 102.

[0108] The rear portion of pusher rod piston 114 has a ledge 123 definedthereon for engagement with take up spring 125 seen in FIG. 3. The rearend 116 of pusher rod piston 114 has a knob 127 thereon which isreceived through a keyhole shaped opening 193 in actuator lever 184.

[0109] The pusher rod piston 114 has an intermediate enlarged diameterportion 126. As seen in FIG. 32, the intermediate outer tube piston 38has a bore 132 defined in its rearward end 134. As seen in FIG. 3, thepusher rod piston 114 is slidably received within the bore 132 ofintermediate outer tube piston 38.

[0110] As previously noted, the barrel 14 has a bore 24 defined in itsforward end 26. The barrel 14 further includes first, second and thirdcounterbores 146, 148, and 150, respectively.

[0111] Third counterbore 150 is closely received about the cylindricalforward extending projection 13 of handle 12.

[0112] The larger diameter forward portion 48 of intermediate outer tubepiston 38 is slidably received in the second counter bore 148. Anintermediate piston return spring 152 is disposed between the forwardend of intermediate piston 38 and a step 154 defined between bore 24 andfirst counterbore 146. Spring 152 can also be described as a jaw returnspring for aiding in opening the jaws.

[0113] The magazine 58 has a transverse pin bore 156 definedtherethrough near its rear end 158 as best seen in FIG. 17. As seen inFIG. 3, an anchor pin 160 extends through the pin bore 156 of magazine58 and into the barrel 14 to anchor the position of magazine 58 relativeto barrel 14.

[0114] As seen in FIGS. 32 and 39, the intermediate outer tube piston 38has first and second longitudinal slots 50 and 52 defined thereinthrough which the anchor pin 160 is received. The slots 50 and 52 allowthe intermediate outer tube piston 38 to slide longitudinally over therear end 158 of magazine 58 and over the anchor pin 160.

[0115] The smaller diameter rearward portion 46 of intermediate outertube piston 38 is slidably received within a bore 162 of a primary outertube piston 164. The primary outer tube piston 164 may also be referredto as a collar 164.

[0116] The primary outer tube piston 164 is best shown in FIG. 30. Itincludes a generally cylindrical forward portion 166 having a forwardend 168. Flats such as 170 are formed on the two diametrically opposedsides of forward portion 166. Integrally formed arms 172 and 174 extendrearwardly from the forward portion 166 and are spaced apart in ayoke-like fashion. The rear end 176 of forward portion 166 has a slot178 formed vertically therethrough.

[0117] A safety spring 180 is concentrically received about the smallerdiameter rearward portion 46 of intermediate outer tube piston 38 and isreceived between the forward end 168 of primary outer tube piston 164and a rearward facing annular face 182 defined on the enlarged portion48 of intermediate outer tube piston 38. Safety spring 180 is a verystiff spring which in normal operation is relatively non-flexing. Thepurpose of safety spring 180 is to prevent deformation of the jaws if anunyielding object is trapped between the jaws preventing the jaws fromclosing, and it supplies added resistance to indicate the jaws areclosed and the clips are advanced.

[0118] The arms 172 and 174 of the primary outer tube piston 164 extenddownwardly and rearwardly into engagement with an actuator or actuatorlever 184, and that relationship will be further described below. Theactuator lever 184 is pivotally mounted within the housing 12 on pivotpin 186.

[0119] The trigger 16 is pivotally mounted within housing 12 on a secondpivot pin 188.

[0120] The details of construction of the actuator lever 184 are bestseen in FIG. 31. It is noted that in FIG. 31, the actuator lever 184 hasbeen rotated 180° about a vertical axis as compared to its position inFIGS. 1 and 3. A transverse pin bore 189 receives the pivot pin 186.

[0121] A lower end 190 of actuator lever 184 engages a rear edge 194 oftrigger 16 as best seen in FIG. 2.

[0122] As the trigger 16 is squeezed to pull it back in to the housing12, it causes actuator lever 184 to pivot in a clockwise direction asseen in FIG. 2 about the pivot pin 186. A return spring 187 biases lever184 and trigger 16 back toward their original position. The returnspring 187 is shown as a compression spring located behind actuator 184.The return spring 187 could be replaced with a torsion spring (notshown) positioned around post 186.

[0123] As best seen in FIG. 31, the actuator lever 184 has a pair oflaterally extending pins 196 on either side thereof. The pins 196 engagerearwardmost camming surfaces 198 and 200 defined on the rear ends ofarms 172 and 174 of primary outer tube piston 164. Thus, as thetrigger-16 is squeezed, and actuator lever 184 pivots clockwise, thelateral pins 196 bearing on camming surfaces 198 and 200 cause theprimary outer tube piston 164 to slide forward.

[0124] The actuator lever 184 has an upper end 191 which has an opening193 defined therethrough. The rear end 116 of pusher rod piston 114 isreceived through opening 184.

[0125] It is noted that the primary outer tube piston 164 has agenerally cylindrical outer surface 166 which is slidably receivedwithin a bore 202 of the cylindrical forward extending handle projection13.

DESCRIPTION OF THE OPERATION OF THE APPARATUS

[0126] Upon squeezing of trigger 16, as the actuator lever 184 begins topivot clockwise, its lateral pins 196, which are in engagement with thecamming surfaces 198 and 200 defined on the rear ends of the arms 172and 174 of primary outer tube piston 164, will push the primary outertube piston 164 forward relative to housing 12. The forward end 168 ofprimary outer tube piston 164 pushes safety spring 180, which withessentially no compression pushes against shoulder 182 of intermediateouter tube piston 38 to move piston 38 forward.

[0127] It will be recalled that the outer tube 18 is firmly engaged byintermediate piston 38, so the outer tube 18 will immediately begin toslide forward out of the bore 24 of barrel 14 as the trigger 16 issqueezed.

[0128] As the outer tube 18 slides forward over the magazine 54 which isfixedly attached to the barrel 14, it will cause the jaws 20 and 22 topivot inwardly toward each other.

[0129] It will be appreciated that only a very small sliding motion ofthe outer tube 18 relative to the clip magazine 58 is required to pivotthe jaws 20 and 22 between their open and closed positions.

[0130] Also as the actuator lever 184 pivots clockwise from the initialposition of FIG. 2 the lever 184 pushes against take-up spring 125 andledge 123 to push the pusher rod piston 114 forward within the bore 132of intermediate outer tube piston 38. As the pusher rod piston 114slides forward, it also moves the pusher rod 102, which is attached topiston 114, forward within the clip magazine 58. Depending upon thefrictional resistance to movement of clips 64 in the magazine 58, therewill be some compression of take up spring 25.

[0131] It is noted that when trigger 16 is squeezed and actuator lever184 begins to pivot, force is immediately simultaneously applied tobegin closing the jaws and to begin pushing the clips. There is a slightdelay in the beginning of movement of the clips due to the compressionof spring 125.

[0132] As seen in FIG. 3, the pusher rod 102 includes a plurality ofprongs 104 which individually engage the clips 64B, 64C, etc.Forwardmost clip 64A is not engaged by push rod 102, but instead abutsthe next clip 64B.

[0133] Preferably the clips 64B, 64C, 64D, etc., have slight spacingstherebetween and do not abut each other. If any of the clips do touch,they only touch slightly, and they do not transfer the pushing forcefrom one clip to another. Instead, if the clips touch slightly, they maymove slightly out of alignment with each other. In any event the clips64B, 64C, 64D are separately engaged by separated prongs 104, and areseparately but simultaneously advanced through magazine 58 by theadvancing motion of push rod 102.

[0134] The forwardmost clip 64A is pushed out of magazine 58 into jaws20 and 22 by the next adjacent clip 64B. As forwardmost clip 64A ispushed forward, the wire loops 72 and 74 will come into registry withreleasing openings 96 and 98 thus allowing the support member 66 andclamping arm 68 of the clip to snap shut toward each other thus clampingthe lumen 100 therebetween as the clip 64A is released from the jaws 20and 22.

[0135] After the trigger 16 has been squeezed to close jaws 20 and 22and advance a clip 64A into the jaws where it is released, subsequentrelease of trigger 16 will cause it to pivot forward due to spring 187.This will pull back the push rod 102. The column of clips 64 will stayin place within magazine 58 due to the gripping of the magazine ledges61 and 63 by the clips 64. The prongs 104 will slip back past the clipsand engage the next rearward clip on the next squeeze of trigger 16. Theability of the prongs 104 to slip back past the clips 64 is aided by thelateral movement allowed by flexible strip 93 which backs up the pushbar 102.

METHODS OF LIGATING A LUMEN

[0136] As previously noted, the apparatus 10 is especially constructedfor use in laparoscopic surgery wherein the apparatus 10 must beinserted through as small an opening as possible in the patient's body.

[0137] U.S. Pat. No. 5,593,414, assigned to the assignee of the presentinvention and incorporated herein by reference, discloses a technologywhich allows a spring clip to be inserted into the surgical field in theclosed state, opened over a vessel, the diameter of which has beenreduced or preclamped by the tool, and then closed over the preclampedvessel. That method allows an entry wound to vessel diameter of 1.0 orsmaller. Thus, a 5 mm vessel can be ligated through a 5 mm diametertrocar.

[0138] One aspect of the present invention is the provision of improvedpreclamping apparatus and methods. Utilizing the apparatus disclosed inU.S. Pat. No. 5,593,414, a vessel is first preclamped at one point alongits length, and then the spring clip is applied over the vessel adjacentthe point of preclamping. This technique is improved by the presentinvention in the following manner.

[0139] It will be appreciated in reference to FIGS. 19 and 22, that thebottom jaw 20 may be described as being bifurcated to include first andsecond spaced jaw sides 214 and 216. Similarly, the upper jaw 22 may bedescribed as being bifurcated to include first and second spaced jawsides 218 and 220.

[0140] When the jaws 20 and 22 are closed together, the first jaw sides214 and 218 clamp the lumen 100 at one point along its length, and thesecond jaw sides 216 and 220 clamp the lumen 100 at a second point alongits length. Then, when the clip 64A is released, the support member 66and clamping arm 68 clamp the lumen at a third point along its lengthlocated between the first and second points.

[0141] The closing motion of jaws 20 and 22 may be described aspreclamping the lumen 100 by movement of clamping surfaces 214, 216, 218and 220 in planes substantially perpendicular to a longitudinal axis 222(see FIG. 37) of the lumen 100.

[0142] It is noted that the step of preclamping the lumen 100 betweenthe jaws 20 and 22 typically occurs prior to the step of pushing thespring clip 64A from the magazine 58 into the jaws 20 and 22. As thespring clip 64A is moved into the jaws 20 and 22, it subsequently isreleased from those jaws when the wire loops move into registry with thereleasing openings 96 and 98.

[0143] It is also noted that the methods of operating the apparatus 10includes steps of loading in a plurality of spring clips 64 in themagazine 58 such that the wire loops 72 and 74 are received within thechannels 60 and 62 with the clips thus held in an open position. Then,each time that the trigger 16 is compressed, each of the clips 64 isadvanced forward in the magazine 58. The clips 64 are arranged inmagazine 58 head to tail with a small space between adjacent clips sothat the clips are pushed through the magazine 58 by the prongs 104 ofthe pusher rod 102.

[0144] During this procedure rotation of the spring clip 64 is preventedby containing the wire loops, or enlarged ends 72 and 74 thereof in thepartially closed channels 60 and 62 of the magazine 58.

[0145] Now with reference to FIG. 38, a method will be described forligating a stub end 224 of a lumen 100. It will be appreciated by thoseskilled in the art, that sometimes instead of placing the clip 64transversely across the length of the lumen 100 as illustrated in FIGS.36 and 37, it will be desirable to approach a stub end 224 of the lumen100 head on. With all prior art clip designs this can be very difficult.

[0146] This can be accomplished with the clip 64 of the presentinvention owing to the wire loops 72 and 74 providing transverselyextending clamping surfaces 226 and 228 (see FIG. 8) which are theforward portions of loops 72 and 74 extending transversely to the lengthof the clip 64.

[0147] With reference to FIG. 38, when clamping a stub end 224 of thelumen 100 the clip 64 will generally be oriented with its length at anangle of less than 45° to a length or centerline 222 of the lumen 100.

[0148] The bullet shaped forward ends 208 and 210 of jaws 20 and 22 areopened and then placed over the stub end 224. Then, the jaws 20 and 22are closed together by squeezing the trigger 16 so as to preclamp thelumen 100 at a point spaced a distance from its stub end 224. Jaws 20and 22 have transverse preclamping surfaces 230 and 232, respectively,defined thereon.

[0149] As the trigger is squeezed the forwardmost clip 64 is advancedinto the jaws 20 and 22 in a lengthwise direction until the wire loops72 and 74 are in registry with the releasing openings 96 and 98, whichmay be described as a position where the stub end 224 of the lumen 100is located between the two transversely extending clamping surfaces 226and 228. Then as the wire loops 72 and 74 move into registry with thereleasing openings 96 and 98, the clip 64A is released and the wireloops 72 and 74 move toward each other thus clamping the stub end 24 ofthe lumen 100 between the two transversely extending clamping surfaces226 and 228 as seen in FIG. 38.

[0150] Thus it is seen that the apparatus and methods disclosed readilyachieve the ends and advantages mentioned as well as those inherenttherein. While certain preferred embodiments of the invention have beenillustrated and described for purposes of the present disclosure,numerous changes in the arrangement and construction of parts and stepsmay be made by those skilled in the art, which changes are encompassedwithin the scope and spirit of the present invention as defined by theappended claims.

What is claimed is:
 1. A surgical clip applicator apparatus for applyinga clip having a support member and a clamping arm, the support memberand the clamping arm each having enlarged portions, comprising: amagazine having first and second longitudinally extending partiallyclosed channels for receiving the enlarged portions of the supportmember and the clamping arm and holding the clip in an open position;and first and second jaws, at least one of the jaws being pivotallymounted relative to the magazine, the jaws having channel extensionstherein aligned with the first and second channels of the magazine, sothat a clip can be received from the magazine in the jaws with the firstand second enlarged portions of the support member and the clamping armbeing received in the first and second channel extensions of the jaws.2. The apparatus of claim 1, wherein; the first and second channelextensions include first and second releasing openings, respectively,larger than the first and second enlarged portions of the support memberand the clamping arm, so that when the clip is pushed forward in thejaws to a position where the enlarged portions are aligned with thereleasing openings, the support member and the clamping arm are releasedallowing the support member and the clamping arm to move toward eachother to ligate a lumen therebetween.
 3. The apparatus of claim 1,further comprising: a pusher rod arranged to push the clip from themagazine into the jaws.
 4. The apparatus of claim 1, further comprising:an actuator assembly, operably associated with the jaws, and movablebetween a first position in which the jaws are open, and a secondposition in which the jaws are closed.
 5. The apparatus of claim 1,wherein: the jaws, when closed together, define a bullet-shaped probeend.
 6. The apparatus of claim 1, wherein: both of the jaws arepivotally mounted relative to the magazine.
 7. The apparatus of claim 1,wherein: the magazine comprises a one piece tubular member.
 8. Asurgical ligation apparatus, comprising: a magazine having first andsecond longitudinally extending, partially closed channels; and a springclip having: a support member and a clamping arm; a spring joining thesupport member and the clamping arm; and first and second controlsurfaces defined on the support member and the clamping arm,respectively, the first and second control surfaces being received inand trapped within said first and second channels, respectively, withthe support member and the clamping arm held apart in an open position.9. The apparatus of claim 8, further comprising: a plurality of suchspring clips loaded in the magazine.
 10. The apparatus of claim 8,further comprising: first and second jaws, at least one of the jawsbeing pivotally attached to the magazine, the jaws having channelextensions therein aligned with the first and second channels of themagazine, so that the clip can be received from the magazine in the jawswith the first and second control surfaces of the support member and theclamping arm being received in the first and second channel extensionsof the jaws.
 11. The apparatus of claim 10, wherein; the first andsecond channel extensions include first and second releasing openings,respectively, larger than the first and second control surfaces of thesupport member and the clamping arm, so that when the clip is pushedforward in the jaws to a position where the control surfaces are alignedwith the releasing openings, the support member and the clamping arm arereleased allowing the spring to bias the support member and the clampingarm toward each other to ligate a lumen therebetween.
 12. The apparatusof claim 10, further comprising: a pusher rod arranged to push the clipfrom the magazine into the jaws.
 13. The apparatus of claim 10, furthercomprising: an actuator assembly, operably associated with the jaws, andmovable between a first position in which the jaws are open, and asecond position in which the jaws are closed.
 14. The apparatus of claim8, wherein: said first and second control surfaces are defined on firstand second wire loops integrally formed with the support member and theclamping arm of the spring clip.
 15. The apparatus of claim 14, wherein:the spring of the spring clip has a pre-load such that when the springclip is in a closed position, the first and second wire loops are forcedagainst each other.
 16. The apparatus of claim 14, wherein: the loopsinclude clamping surfaces extending transverse to a length of themagazine so that a vessel stub can be clamped head on by placing thejaws head on over the vessel stub and releasing the clip.
 17. Theapparatus of claim 8, wherein: the jaws, when closed together, define abullet-shaped probe end.
 18. A surgical ligation apparatus, comprising:a magazine; and a plurality of resilient clips resiliently biased towarda closed position and received within the magazine and held in an openposition by the magazine.
 19. The apparatus of claim 18, wherein: eachof the resilient clips resiliently grips the magazine so that there is africtional resistance to movement of the clips through the magazine. 20.The apparatus of claim 19, further comprising: a driver rod individuallyengaging each of a plurality of the clips to individually move each ofthe plurality of clips through the magazine.
 21. The apparatus of claim20, wherein: each of the plurality of clips engaged by the driver rod isseparate from and does not touch any of the other clips engaged by thepusher rod.
 22. The apparatus of claim 21, wherein: the forwardmost clipengaged by the driver rod is the next to last clip forward in themagazine, and abuts against the last clip forward in the magazine sothat the last clip forward in the magazine is pushed out of the magazineby the next to last clip forward in the magazine.
 23. A surgicalligation apparatus, comprising: a magazine; a plurality of resilientclips received within the magazine at least a majority of which clipsare each located separate from and not in force transferring engagementwith any of the other clips; and a driver rod individually engaging eachof the majority of the plurality of clips, to individually move each ofthe majority of the plurality of clips through the magazine.
 24. Theapparatus of claim 23, wherein: each of the resilient clips includes asupport member and a clamping arm which are held apart in an openposition by the magazine so that the clip resiliently grips the magazinebetween the support member and the clamping arm and there is africtional resistance to movement of the clips through the magazine. 25.The apparatus of claim 24, wherein: the driver rod includes a pluralityof separate prongs each one of which prongs engages one of the clips.26. A surgical clip applicator apparatus for ligating a vesselcomprising: a body; a magazine extending from the body along alongitudinal axis; a rotator connecting the magazine to the body so thatthe magazine can be rotated about its longitudinal axis relative to thebody; a resilient clip received in the magazine; and first and secondjaws, at least one of the jaws being pivotally mounted relative to themagazine, for receiving the clip from the magazine about the vessel tobe ligated, the first and second jaws having first and second windows,respectively, defined therein located diametrically opposite each otherabout the longitudinal axis so that the vessel can be viewed through thewindows when the vessel is received between the jaws.
 27. A surgicalligation clip comprising: a support member and a clamping arm; aconnector joining the support member and the clamping arm; and first andsecond enlarged ends defined on the support member and the clamping arm,respectively, the first and second enlarged ends including first andsecond wire loops, respectively integrally formed with support memberand the clamping arm of the clip.
 28. The clip of claim 27, wherein theconnector includes a bias means having a pre-load such that when theclip is in a pre-loaded equilibrium position, the first and second wireloops lay one upon the other with the connector biasing the loopstogether.
 29. The apparatus of claim 27, wherein: the loops includeclamping surfaces extending transverse to a length of the support memberand the clamping arm so that a vessel stub can be clamped head-on byplacing the clip head-on over the vessel stub and releasing the clip.30. The clip of claim 27, wherein: the support member includes twoparallel spaced apart lengths of wire lying in a first plane; and theclamping arm includes a single length of wire which pivots about thespring in a second plane normal to the first plane and intersecting thefirst plane between the two parallel spaced apart lengths of wire of thesupport member.
 31. The clip of claim 27, wherein: the clip has a throatlength of no greater than 10 mm.
 32. The clip of claim 27, wherein: theconnector includes a spring a pre-load force between the support memberand the clamping arm of at least 100 grams of force.
 33. The clip ofclaim 27, wherein: the clip is formed of a single length of bent wire.34. A wire spring clip for ligating a lumen, comprising: a transversespindle having a first free end, and terminating in a bend which leadsto a first longitudinal member which terminates in a first wire loopwhich leads to a second longitudinal member lying parallel to the firstlongitudinal member and spaced therefrom, the first wire loop having atransverse dimension greater than a transverse distance across the firstand second longitudinal members, the second longitudinal memberterminating in a coil spring wrapped around the transverse spindle, thecoil spring leading to a third longitudinal member which terminates in asecond wire loop which terminates in a second free end.
 35. The clip ofclaim 34, wherein; the coil spring has a pre-load such that when theclip is in a closed position the first and second wire loops lay oneupon the other with the coil spring forcing the loops against eachother.
 36. The clip of claim 35, wherein: the loops include clampingsurfaces extending transversely so that a vessel stub can be clampedhead-on between the transversely extending clamping surfaces.
 37. Theclip of claim 34, wherein: the first and second longitudinal members liein a first plane; and the third longitudinal member pivots about thecoil spring in a second plane normal to the first plane and intersectingthe first plane between the first and second longitudinal members.
 38. Amethod of ligating a lumen, comprising: (a) loading a plurality ofspring clips in a magazine, the magazine having first and secondpartially closed channels, and the spring clips having first and secondenlarged portions received in the first and second partially closedchannels so that the spring clips are held in an open position; (b)advancing the spring clips in the magazine with the spring clips in theopen position; (c) preventing rotation of the spring clips by containingthe first and second enlarged portions in the first and second partiallyclosed channels of the magazine; (d) pre-clamping the lumen at first andsecond spaced clamping points along the length of the lumen; (e) placingthe forwardmost spring clip over the lumen; and (f) clamping the lumenwith the forwardmost spring clip at a third point located between thefirst and second points.
 39. The method of claim 38, step (d) comprisespre-clamping the lumen by movement of clamping surfaces in planessubstantially perpendicular to a longitudinal axis of the lumen.
 40. Themethod of claim 38, wherein: step (d) includes pre-clamping the lumenbetween a pair of jaws, each jaw being bifurcated to include first andsecond spaced jaw sides; step (e) includes moving the spring clip fromthe magazine into the jaws; and step (f) includes releasing the springclip from the jaws.
 41. A method of ligating a stub end of a lumen,comprising: (a) providing a spring clip having a length and having twotransversely extending clamping surfaces extending transverse to thelength of the clip; (b) orienting the clip with its length at an angleof less than 45° to a length of the stub end; (c) extending the clip ina lengthwise direction to a position where the stub end of the lumen islocated between the two transversely extending clamping surfaces; and(d) releasing the clip and clamping the stub end of the lumen betweenthe two transversely extending clamping surfaces.
 42. The method ofclaim 41, further comprising: prior to step (e), pre-clamping the stubend of the lumen between the blunt nose ends of a pair of articulatedjaws.
 43. A method of ligating a vessel, comprising: (a) loading aplurality of resilient clips in a magazine with the clips in an openposition; (b) advancing the clips through the magazine while the clipsare held in their open position; (c) placing a forwardmost one of theclips over the vessel to be ligated; and (d) releasing the forwardmostclip so that it moves toward a closed position thereby ligating thevessel.
 44. The method of claim 43, wherein: step (a) includes holding asupport member and a clamping arm of each clip in first and secondpartially closed channels of the magazine and thereby holding the clipsin the open position.
 45. The method of claim 43, wherein: in step (a),the clips resiliently grip the magazine thus providing a frictionalresistance to movement of the clips relative to the magazine.
 46. Themethod of claim 45, wherein: step (b) includes separately engaging eachof a majority of the plurality of clips in the magazine, and separatelysimultaneously advancing each of the separately engaged clips.
 47. Themethod of claim 43, wherein: step (b) includes separately engaging eachof a majority of the plurality of clips in the magazine, and separatelysimultaneously advancing each of the separately engaged clips.
 48. Aligation clip applicator apparatus, comprising: a body; a clip magazinehaving a rear end fixedly attached to the body, and having a forwardend; a pair of jaws pivotally attached to the forward end of the clipmagazine; and an outer tube received about the clip magazine and beingslidable relative to the body and the clip magazine, the outer tubebeing operably engaged with the jaws so that the jaws are moved betweentheir open and closed positions as the outer tube slides relative to theclip magazine.
 49. The apparatus of claim 48, further comprising: apusher rod, slidable relative to the clip magazine, for moving aplurality of clips lengthwise through the magazine.